The document is a Vermont Sales Tax Exemption Certificate for fuel or electricity. It allows buyers to claim an exemption for fuel or electricity purchases under one of three categories: residential use, agricultural use, or manufacturing use. The buyer fills out their name and address, the seller's name and address, checks the applicable exemption category, and signs and dates the form. It is valid for three years unless replaced or withdrawn, and the seller must retain it for three years after the last covered sale.